Reduction of Exit-Site Infections in Peritoneal Dialysis by Local Application of Metallic Silver: A Preliminary Report

Kahl, Andreas; Große-Siestrup, Christian; Kahl, Karen A.; Becker, H; Leimbach, Til; Wagner, J. D.; Gahl, Gerhard M.

doi:10.1177/089686089401400217

Cited by 15 publications

(15 citation statements)

References 11 publications

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“…Therefore, based on present evidence it would appear that silver is not effective at reducing or preventing exit-site infections or peritonitis in PD patients. 12,32 Results for the use of dressings for the prevention of exitsite infections and/or peritonitis are also inconclusive. A single RCT of low power found no difference in the effectiveness of gauze, OpSite dressings, or no dressings in reducing the rate of exit-site infections or peritonitis.…”

Section: Discussionmentioning

confidence: 99%

“…Sixteen of these articles dealt with the effectiveness of forms of exit-site care to prevent infection or peritonitis, and were included. 6,[10][11][12][13][26][27][28][29][30][31][32][33][34][35][36] A summary of the study populations, methods, interventions and outcome measures for the included studies can be found in Appendix III. A further 115 papers were excluded for reasons of wrong study type, review or discussion paper, incorrect outcome(s) or intervention(s) (Appendix IV).…”

Section: Description Of Studiesmentioning

confidence: 99%

“…Two studies that met Peritonitis due to all organisms, povidone-iodine spray vs no spray the inclusion criteria for this review examined the effectiveness of silver for preventing exit-site infections and peritonitis in patients treated by PD. 12,32 In a small concurrently controlled trial (n = 34), use of a silver ring (n = 20) placed in contact with the exit-site was compared with a control group (n = 6) who were not allocated a silver ring. 12 The silver ring group's pre and post intervention data were also compared.…”

Section: Silvermentioning

confidence: 99%

“…12,32 In a small concurrently controlled trial (n = 34), use of a silver ring (n = 20) placed in contact with the exit-site was compared with a control group (n = 6) who were not allocated a silver ring. 12 The silver ring group's pre and post intervention data were also compared. Group allocation was not randomised, and the controls were taken from the 11 patients who initially refused to participate in the silver ring group; hence, what would have been a before and after study was expanded to include a concurrent control group.…”

Section: Silvermentioning

confidence: 99%

“…Typically, these involved the use of multifaceted interventions inclusive of cleaning with solutions such as potable tap water through to antibiotic or antiseptic solutions, the application or avoidance of covering dressings, and the use of antiseptic devices to assist in maintaining an infection free exit site. 2,4,5,[7][8][9][10][11][12] Current practice in each of these areas is variable and the optimal approach to exit-site care is not known. One survey of nurses and medical staff with 585/1800 respondents from across the USA found the most frequently performed aspects of exit-site care were daily hygiene, application of catheter stabilisation dressings, and use of cleansing agents.…”

Section: Introductionmentioning

confidence: 99%

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Clinical effectiveness of different approaches to peritoneal dialysis catheter exit-site care

Lockwood

Hodgkinson

Page

2003

JBI Database of Systematic Reviews and Implementation Reports

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Executive summaryObjective The objective of this review was to appraise and synthesise the best available evidence on the clinical effectiveness of peritoneal dialysis catheter exit-site care. Inclusion criteriaThis review considered all randomised controlled trials that evaluated the effectiveness of peritoneal exit-site care. In the absence of randomised controlled trials, other controlled research designs such as non-randomised controlled trials were considered for inclusion in a narrative summary to enable the identification of current approaches and possible future strategies. Participants of interest were adults with chronic renal failure on maintenance peritoneal dialysis. Interventions of interest were those used to manage peritoneal catheter exit sites, and included types of dressings, frequency of dressings, types of skin care, and use of topical antiseptic or antimicrobial agents. Search strategyThe search sought to find both published and unpublished studies.An initial limited search of MEDLINE and CINAHL databases was undertaken to identify key words contained in the title or abstract, and index terms used to describe relevant articles. A second extensive search was undertaken using all identified key words and index terms. The third step was a search of the reference lists and bibliographies of all relevant articles.Methodological quality All identified studies that met the inclusion criteria were assessed for methodological validity by two reviewers prior to inclusion in the review. Critical appraisal of studies focused on identifying bias in selection, performance, attrition and detection. ResultsThis review found few studies of sufficient quality to meet the inclusion criteria.The included studies often utilised historical control groups, potentially confounding measurement of their outcomes. The outcome measures varied considerably, thus meta-analysis was not possible. ConclusionsThis review suggests topical mupirocin may reduce the risk of exit-site infection; however, the clinical effectiveness of any one antibiotic, antiseptic or dressing 168 C Lockwood et al.

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Section: Discussionmentioning

confidence: 99%